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The writing on the wall

The Prophet Daniel tells a famous tale of how the tyrannical king of Babylon held a feast for all his top lords and ladies, and as the feasting grew to fever pitch a mysterious hand appeared from nowhere that started...

Jun/Jul 2017 Quiz

History A 57-year-old female patient presented with gradual painless diplopia over the last six months. Examination revealed restricted upward eye movements and 4mm proptosis which did not increase with Valsalva manoeuvre. Intraocular pressure was normal, no visual defects were noted,...

Third nerve palsy

Case scenarios A 71-year-old female presented to a nearby eye emergency unit with two days history of partial ptosis in her left eye with diplopia. She saw her GP earlier that day and he asked her to go to the...

A practical guide to anisocoria

Anisocoria means the presence of difference in the size of the right and left pupils. It is a sign of an abnormality in the efferent pathway. The first question facing the ophthalmologist is to ascertain if anisocoria is present or...

Headaches in ophthalmology (part 1)

Ophthalmologists see a large number of patients with headaches or facial pain in the ophthalmic outpatient clinics or in emergency clinics. Over two articles, I will discuss several causes of headaches, ocular manifestations and proposed management and referral options. It...

Internuclear ophthalmoplegia: a case study

A 44-year-old patient presents with binocular, mostly horizontal diplopia when fixating on moving objects. This has been ongoing for approximately five years. He is known to have multiple sclerosis and had an episode of optic neuritis six years prior in...

Hydroxychloroquine toxicity

Being the subject of litigation is stressful and upsetting. Having to look back over your previous decisions and justify the care you delivered in good faith can be difficult. Sadly, we all live with the Sword of Damocles above us...

The results of the last survey Aug 2020

Once more I would like to thank those of you who took the time to complete the last edition’s survey. It was highly pertinent to what we are facing now. It is clear that our services have been markedly disrupted....

The results of the last survey Jun23

*Please be aware that this data does not form part of a peer reviewed research study. The information therein should not be relied upon for clinical purposes but instead used as a guide for clinical practice and reflection. I continue...

If looks could kill – kohl and the eye

Simerdip Kaur takes a look at the latest ophthalmology-related news stories and asks which are based on facts and which are ‘fake news’. Headline: If looks could kill – kohl and the eye Human fascination with beautification can be traced...

Cyanoacrylate nail glue accidentally instilled into the eye instead of eye drops

Three hundred thousand cataract operations take place each year in the UK alone and each patient will receive a four week course of drops in order to cover them for any postoperative inflammation or infection. Accidental instillation of cyanoacrylate glue...

Acute retinal necrosis presumably caused by Epstein-Barr virus infection

Acute retinal necrosis (ARN) is an uncommon, but serious and potentially blinding condition. ARN is characterised by panuveitis, occlusive vasculopathy and progressive peripheral necrotising retinitis. The diagnosis is clinical but confirmation is sought via aqueous and vitreous sampling. Varicella zoster...